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Sexual dysfunction
Last reviewed: 08.07.2025
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A decrease in sexual desire can be defined as a prolonged, marked decrease or loss of sexual desire. Individuals with these disorders exhibit a deficit in desire or interest in sexual activity, usually due to a lack of sexual fantasies.
Some people report a lifetime of no desire for sex. For others, the problem develops after years of "sexual appetite." In some cases, sexual desire disorder occurs after other sexual problems have developed, such as a man who has had difficulty achieving an erection with his wife for years and eventually loses interest in sex. Similarly, a woman who experiences pain during intercourse may lose all desire for sex.
Causes and Treatment Disorders associated with decreased sexual desire may be caused by organic reasons, so they require medical examination. These problems may be of a hormonal nature. In such cases, hormone therapy is often useful. Other causes may be depression, mental conflicts (including fear of declaring one’s sexual needs) or problems during sex.
The effectiveness of treatment lies in the combination of:
- Cognitive therapy, in which the patient's attitudes and way of thinking are oriented towards sex.
- Behavioural therapy in the form of sensitizing exercises in accordance with the requirements of sexual communication.
- Couples psychotherapy, where specific issues of sexual life are discussed, such as when it is possible to have sex, what to do if a young woman does not show independent interest in sex, etc.
Disorders manifesting in sexual aversion
In disorders accompanied by sexual aversion, there is a long-term or frequent aversion to any sexual activity with a partner, fear of sex, and avoidance of it. The most common cause of this disorder is sexual trauma. For example, one 33-year-old woman was raped by her stepfather at the age of nine. This experience left physical and psychological consequences. As an adult, this woman avoided any sexual contact. Other possible causes may be fear of intimacy and intrapsychic conflicts.
Sexual psychotherapy for this disorder focuses on overcoming fear. Patients first discuss the ideas that cause them fear. In addition, tricyclic antidepressants may be helpful in such cases.
Sexually related pain
If a man or woman experiences pain during sexual intercourse, they are diagnosed with dyspareunia. This disorder is more common in women. Medical examinations are aimed at excluding organic causes of this disorder, which include vaginitis (inflammation of the vagina), infectious lesions of the urinary tract, vaginal scars, ligament damage, endometriosis (proliferation of the mucous membrane of the uterus) and purulent inflammation. If organic disorders are excluded, therapy should be aimed at overcoming the underlying fear of this disorder, associated with the possibility of physical injury. Processing this fear helps resolve the problem. If a woman experiences an involuntary spasm in the outer third of the vagina, preventing the insertion of the penis, then vaginismus is diagnosed - a spasm of the vagina. Sexual trauma and the fear caused by them are the main causes of this disorder. Treatment is achieved through systematic desensitization, which gradually achieves dilation and stretching of the vagina by inserting tampons or fingers, which over time makes penetration habitual.
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